A major-risk environment can impact nurses' expectations moderated by medical institutional trust and communication.

Background: Nurses' positive expectations of patients in medical interactions constitute an important component of nurse-patient trust and can foster good nurse-patient relationships; therefore, it is critical to investigate factors that influence nurses' expectations. This study aims to examine the relationship between nurses' institutional trust, nurse-patient communication, and nurses' expectations of patients before and after the outbreak of the COVID-19 pandemic.

Methods: Self-reported questionnaires were administered to 1752 nurses (M_age = 32.14 years, SD = 7.62) before the COVID-19 outbreak and 768 nurses (M_age = 29.48 years, SD = 5.51) after the COVID-19 outbreak to assess their medical institutional trust, communication skills, and expectations of patients. Mediational models were constructed to examine the relationship between these variables.

Results: Before the outbreak of the COVID-19 pandemic, there was a significant positive correlation between nurses' medical institutional trust and their expectations of patients, with nurse-patient communication serving as a mediator. During the COVID-19 pandemic, the association between nurses' medical institutional trust and expectations of patients was nonsignificant; however, a significant mediating effect of nurse-patient communication remained between nurses' medical institutional trust and expectations of patients.

Conclusions: Improving nurses' trust in medical institutions may enhance their positive expectations of patients. Healthcare managers should make efforts to foster nurses' trust in healthcare institutions. Furthermore, nurse-patient communication plays a critical mediating role between nurses' medical institutional trust and their expectations of patients, highlighting the importance of interventions and training programs that improve nurses' communication skills, especially when encountering high-risk circumstances.